Sunday, May 28, 2006

Indonesia: coffee's on

Tamiflu is being flown to Asia by the US, although there remains much confusion about the number of tablets, their source and who controls the tablets and where they will be located. An AP story says there are 9500 treatment courses (presumably 95,000 tablets) from a WHO stockpile, but Secretary Leavitt said it was from a stockpile controlled by the US, not WHO. AP also says the drug along with protective gear was flown into Indonesia on Friday, although rumor had it on its way to Singapore or to Clark AFB in the Philippines. WHO spokesperson Maria Chang said it was likely control would be handed over to the Indonesian government, contradicting Leavitt's claim. Since the Indonesian government is widely considered both corrupt and incompetent, this seems a questionable move. However, it is a wise rule of thumb not to believe everything being said at this point, especially if it comes from or is meant to mollify the Indonesian Ministry of Health.

Not that WHO pronouncements seem very plausible, either. WHO has alerted Tamiflu's maker, Roche, that some of a 3 million treatment course set Roche set aside for use by WHO may be called upon for use in Indonesia. Don't worry. Just routine:
No further action on the emergency supply was expected for now, according to the U.N. health agency, which called the alert part of its standard operating procedure when a case arises like that in Indonesia.

"We have no intention of shipping that stockpile," WHO spokesman Dick Thompson cautioned. "We see this as a practice run." (AP)
Standard Operating Procedure? Well they've never done it before, so I guess they are setting the standard now for the operating procedure. But what exactly is the standard (not to mention the operating procedure)?

The seven person cluster of one extended family, spread out over at least three incubation periods (all have now died), began at the end of April, with cases dying through the first three weeks in May. WHO in Jakarta was only officially notified on May 22. CDC had people in-country but they were not invited to consult until mid-May. From what I hear third hand, NAMRU2 is not invited to be part of investigations, although this may have changed. The locals are hostile to the government. Indonesia has an active volcano and just suffered a catastrophic earthquake on its main island. The government is ineffective, slow, inefficient and passive aggressive toward international scientists.

Oh, and this:
Meanwhile, Nyoman Kandun, a senior official at Indonesia's health ministry, said a WHO laboratory in Hong Kong had confirmed five more cases of human bird flu, three of which were fatal. All five had earlier tested positive for the virus in a local laboratory.

The latest confirmed deaths were a 39-year-old man from Jakarta, a 10-year-old girl from West Java and a 32-year-old man, who on Monday became the last to die in the Kubu Simbelang cluster. (AP)
WHO so far has decided not to raise the Pandemic Threat Level from 3 to 4. But the facts speak for themselves.

Wake up and smell the Indonesian coffee!